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Office of the Dean of Undergraduate and Graduate StudiesInternational Graduate Student Application Supplement PacketThe forms included in this packet must be completed by Providence College graduate program applicantswho require F-1 visa sponsorship in order to study in the United States.Providence College will not issue your Certificate of Eligibility (Form I-20) until you have submitted alldocuments. Additionally, being accepted into your Providence College graduate program is not aguarantee of F-1 visa issuance by the U.S. Government.Please submit all of the documents listed below no later than three months prior to the start of classes.Send all documents to Dr. Janet Ray, Assistant Dean/Director of International Student Success, one of thefollowing ways:1. By Mail –Dr. Janet RayProvidence CollegeOffice of the Dean for Undergraduate & Graduate StudiesHarkins Hall 2131 Cunningham SquareProvidence, RI029182. By Email – jray@providence.edu*If you send these documents by email, then you must provide the original versions in person by the first day of classes.Required DocumentsComplete: Personal Information Form Maintaining Your F-1 Status Agreement Certification of Finances Form Immunization Records Form Health Insurance Form eShip Global AgreementAttach: Copy of Program Acceptance Letter Passport Copy – Photo ID Page Bank Statements and Financial Sponsor Letters TOEFL/IELTS ScoresPERSONAL INFORMATION FORM0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudiesSemester you plan to begin your studies:Fall 20Spring 20Summer 20I am beginning the Graduate Degree Program in: (check one) Biblical StudiesTheologyTheological StudiesBusiness Administration (MBA)HistoryTeaching Mathematics Education – PACTEducation – AdministrationEducation – CounselingEducation – LiteracyEducation – Special EducationEducation – Urban TeachingFull Legal Name (as shown on passport):Family/SurnameFirst/Given NameDate of Birth: / /MonthDayMiddle Name(s)MaleFemaleYearCountry of Citizenship:Country & City of Birth:Current Country of Residence:US Social Security Number (if any):Passport Number:Passport Expiration Date: / /MonthDayYearNative Language: If your native language is not English, attach your TOEFL or IELTS scores.E-Mail Address: Cell Phone Number:Permanent Address:Street:City: State/Province: Postal Code: Country:Mailing Address (if different from permanent address):Street:City: State/Province: Postal Code: Country:If Currently in the United StatesType of Visa:Expiration Date: / /MonthDayYearSEVIS ID: Number on I-94 (entry document):0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudiesMAINTAINING STATUS YOUR F-1 STATUS AGREEMENTAs a student on an F-1 visa to study in the United States, you must adhere to the governmental regulations of yourvisa status.Failure to follow these regulations could result in the termination of your visa. If your visa is terminated, you mustdepart the U.S. within 15 days and you will not be eligible for U.S. re-entry on your Providence College I-20.ALWAYS NEVER Maintain a valid passportAttend the school whose name appears on your I-20Register for, and complete, at least 9 credits each semesterMaintain a valid I-20o Apply for an I-20 extension at least one month before the I-20 expiration dateObtain I-20 travel signature from the Assistant Dean of International Studies before you depart the U.SMaintain valid health insuranceNotify the Assistant Dean/Director of International Student Success within 10 days of an address ortelephone number changeDo one of the following within 60 days after program completiono Depart the U.S.o Transfer and obtain an I-20 for a new school or program and enrollo Change to another immigration statusDepart the country within 15 days of withdrawal or dismissal from Providence CollegeConsult the Assistant Dean of International Studies in order to initiate an academic transfer to anotherU.S. institutionWork off-campus without authorization from the Assistant Dean/Director of International StudentSuccessWork on-campus more than 20 hours per week while school is in sessionTake a leave of absence without authorization from the Assistant Dean/Director of International StudentSuccessDrop below full-time (9 credits) without authorization from the Assistant Dean/Director of InternationalStudent SuccessAccept an I-20 signature or immigration advice from anyone other than one of the school’s DesignatedSchool Official or Principal Designated School Official.I have read and understand the regulations I must follow in order to maintain my F-1 visa status. I understand that Ishould ask the Assistant Dean/Director of International Student Success if I have any questions about maintainingmy status.Name:Signature:Date:0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudiesCERTIFICATION OF FINANCES FORM (1 of 2)International students are required to demonstrate that they have the necessary funds to support their studies atProvidence College. Before an I-20 is issued, students must certify that they can pay for the first year’s expenses.Students should expect that the tuition and fees will increase by a moderate amount from year to year.To find the expenses, please visit the PC Graduate Programs Financial Information web page:https://bursar.providence.edu/graduate/Cost of Attendance (subject to change per academic year)Tuition (MBA). Tuition per 3 credit x 3Tuition (Arts & Sciences) . Tuition per 3 credits x 3Tuition (Professional Studies) . Tuition per 3 credits x 3Living Expenses. 10,000Student Health Insurance (estimate) . 1,500Books (estimate) . 1,000(PLEASE SEE LINK ABOVE FOR TUITION EXPENSES)While on-campus employment in the form of a Graduate Assistantship may be available, it is not guaranteed; ifawarded campus employment, the hours that can be worked are limited by a student's visa status. As such,students should not include anticipated on-campus earnings as part of their funding projections.Keep a copy of the Certification of Finances Forms for your visa appointment and personal records.Full Legal Name (as shown on passport):Family/Surname1.First/Given NameMiddle Name(s)Enter in U.S. Dollars (USD) the expected amount of annual funds available to you. Leave blank any sectionwhere you will not be receiving financial support. The total amount should equal or exceed the cost ofattendance.STUDENT'S SOURCES OF FUNDSPersonal or Family Savings:Assured Support1st Year2nd Year Parents or Sponsors: List name and relationship of each sponsor.1.2.3.Government scholarship(s): Attach an award letter. Other funds: Please specify. TOTAL AMOUNT: 0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate Studies2. Attach official certification of sources of funds and amounts. Certified bank statement, including a 90 day history of all deposits Letter from the bank including the bank official’s name and title, and the bank’s name andaddress.If you will be financially supported by outside sponsoring parties (family member, government,company, friend), then submit a notarized, signed letter from each sponsoring party indicating theamount in USD that will be available to you each year.CERTIFICATION OF FINANCES FORM (2 of 2)3. What is the present exchange rate of your country’s currency to the U.S. Dollar?Name of Currency: Amount of Currency: 1.004. Does your government currently impose restrictions on the exchange and release of funds for study in theU.S.? Yes NoIf YES, describe restrictions.5. Do you have a source for emergency funds once you arrive in the U.S.?YesNoIf YES, name source Amount available in U.S. dollars 6.How will you pay for transportation to the U.S.?7. What is the total amount of money you expect to have when you arrive at Providence College?U.S. By my signature below, I certify that the information included on these Certification of Finances Forms is true,correct, and complete. I understand and agree that any misrepresentation may be cause for refusing or revoking myadmission to Providence College. I understand and agree that I have a duty to disclose to and update ProvidenceCollege about any information that substantially alters the information requested in these Forms.Signature:Date:0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudiesPayment Tip: Use PayToStudy for cheaper, faster, and easier payments to Providence CollegePayToStudy offers a fast and secure way to send payments globally at no cost to the sender or the recipient.1. Student Registers for PayToStudy: https://prcol.studentfees.com/The sender registers on the secure PaytoStudy domain and enters their payment details.2. Student Makes Payment into AccountThe sender receives the exchange rate for that day (valid for 48 hours) and makes payment into thePayToStudy bank account in their home country and in their local currency.3. PayToStudy Makes Payment to SchoolOnce funds are received by PaytoStudy, payment is immediately transferred to the receivers accountfrom the local PaytoStudy account in their home country.0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudiesIMMUNIZATION RECORD FORM (1 of 2)Providence College policy and Rhode Island State law require the College to keep a medical immunization recordform on file for all full-time, degree-seeking students. Proof of immunization is required prior to course registration.This form must be completed and signed by a physician or the physician may attach valid proof of medical recordsshowing the immunizations received. Acceptable evidence must include the day, month, year, and type/name ofeach dose of the vaccine administered.Student’s Name: Date of Birth: / /MonthA. Tetanus-Diphtheria: Required1. Tetanus-Diphtheria booster within last ten yearsDate: / /MonthB. M.M.R. (Measles, Mumps, and Rubella): Two Doses Required1. Dose 1 (on or after first birthday)YearDayYearDate: / /MonthC. Varicella (Chicken Pox): Required1. Had disease2. Vaccinated –Dose 1Dose 2*Completed primary series of polio vaccinationsType of vaccineLast BoosterDayYearDayYearDate: / /MonthDayYearYes NoOral IPVDate: / /MonthE. Hepatitis B Series: Required1. Dose 1YearDate: / /Month*2nd Varicella vaccine is required if 1st dose was administered on or after the 13th birthdayDayDate: / /MonthD. Polio:DayDate: / /Month2. Dose 2DayDayYearDate: / /MonthDayYear2. Dose 2Date: / /3. Dose 3Date: / /MonthMonth0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.eduDayDayYearYearYear
Office of the Dean of Undergraduate and Graduate StudiesIMMUNIZATION RECORD FORM (2 of 2)Tuberculosis ScreeningCopy of EMR accepted, however, Tuberculin screening questions must be current. Student signature and date are REQUIRED.1.Does the student have signs or symptoms of active TB disease? Yes Noo If NO, then proceed to question 2.o If YES, then proceed with additional evaluation to exclude active TB disease, including tuberculin skintesting, chest x-ray, and sputum evaluation as indicated.2. Is the student a member of a high-risk group* (see below) or is the student entering the health professions?Yes Noo If NO, then stop and sign the form. No further evaluation is needed at this time.o If YES, then it is necessary to have a Tuberculin skin test. A history of BCG vaccination should notpreclude testing of a member of a high-risk group.3. Tuberculin Skin TestDate administered: / /MonthDayYearDate read: / /MonthDayYearResult: (Record actual mm of duration, transverse diameter. If no induration, write “0”)Interpretation (based on mm of induration as well as risk factors). Positive Negative4. Chest X-ray (required if tuberculin skin test in positive)Date of Chest X-ray: / /MonthDayResult: Normal AbnormalYearStudent Signature: Date Answered:Health Care Provider (Provider’s signature, contact information, and date of exam are required – Please PRINT information)Provider Name: Date of Exam:Provider’s Signature: Phone: Fax:Street:City: State/Province: Postal Code: Country:*1. The American College Health Association has published guidelines on tuberculosis screening of college and university students. These guidelines are basedon recommendations from the Centers for Disease Control and the American Thoracic Society. For more information, visit www.acha.org or refer to the CDC’sCore Curriculum on Tuberculosis available at state health departments or at the following website: www.cdc.gov/nchstp/th/pubs/corecurr/.2. Categories of high-risk students include those students who have arrived within the past five years from countries where TB is endemic. It is easier to identifycountries of low, rather than high, TB prevalence. Therefore, students should undergo TB screening if they have arrived from countries EXCEPT those on thefollowing list: Canada, Jamaica, Saint Kitts and Nevis, Saint Lucia, US Virgin Islands (USA), Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland,Italy, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Norway, San Marino, Sweden, Switzerland, United Kingdom, American Somoa, Australia, or NewZealand. Other categories of high-risk students include those with HIV infection, who inject drugs, who have resided in, volunteered in, or worked in high-riskcongregate settings such as, prisons, nursing homes, hospitals, residential facilities for patients with AIDS, or homeless shelters; and those who have clinicalconditions such as diabetes, chronic renal failure, leukemias or lymphomas, low body weight, gastrectomy and jejunoileal by-pass, chronic malabsorptionsyndromes, prolonged corticosteroid therapy (e.g. prednisone 15 mg/d for one month) or other immune-suppressive disorders.0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudiesHEALTH INSURANCE FORMHealth insurance coverage is REQUIRED by the federal government for international students to maintain their visastatus. Proof of health insurance must be provided to the Center for International Studies by the first day of classes.Students must demonstrate proof of coverage for a minimum of the nine months of the academic year.Exceptions:o Students taking summer courses must demonstrate 12 months of coverageo Students who will complete their program in less than nine monthsStudents may choose any one of the following plans.OPTION 1: Providence College Student Health Insurance Plan Offered through University Health Plans More information may be found here: www.universityhealthplans.com/ProvidenceOPTION 2: iNext Insurance Plan for International Students Two levels of coverage are offered – Navigator and Navigator Plus May choose to purchase coverage only for the amount of time you will be studying in the United Statesduring the next year. The cost is based on age and level of coverage. More information on the insurance plan and cost breakdowns may be found ON 3: ISO Plan for International Students Five levels of coverage are offered – COMPASS Silver, COMPASS Gold, ISO Med 1, Shield 500, Shield 3000 May choose to purchase coverage only for the amount of time you will be studying in the United Statesduring the next year. The cost is based on age and level of coverage. More information on the insurance plan and cost breakdowns may be found here: https://www.isoa.org/ I understand that I am responsible for purchasing health insurance coverage for the duration of my time inthe U.S.I will submit proof of my health insurance coverage to the Assistant Dean of International Studies no laterthan the first day of my classes. I understand that I must demonstrate proof of purchasing health insurancefor a minimum of nine months by submitting a receipt. I also must submit a copy of my insurance card.I acknowledge that failure to show adequate proof of health insurance coverage by the first day of classeswill result in a HOLD being placed on my account, which will prevent me from registering for future coursesat Providence College.Name:Signature:Date:0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Office of the Dean of Undergraduate and Graduate StudieseSHIP GLOBAL MAILING AGREEMENTProvidence College has partnered with eShip Global University Express Mail Services so that international studentsmay arrange for their important documents, such as the Certificate of Eligibility, to be mailed from the U.S. to theircurrent residence.How It WorksStudent CreatesStudent creates a request to have documents mailed.Student PaysStudent pays by Credit Card, Paypal, or Wire Transfer.University ShipsProvidence College processes and ships the package.Carrier DeliversCarrier picks up and delivers. Student chooses the carrier: Federal Express, UPS, DHL.More information is available here: e 8I understand that I am responsible for paying the fee to have my documents mailed to my current address.Name:Signature:Date:0ne Cunningham Square Harkins Hall 213 Providence, Rhode Island 02918-0001Tel: 401.865.2495 Fax: 401.865.1496 Email: jray@providence.edu
Providence College Office of the Dean for Undergraduate & Graduate Studies Harkins Hall 213 1 Cunningham Square Providence, RI 02918 2. By Email - jray@providence.edu *If you send these documents by email, then you must provide the original versions in person by the first day of classes. Required Documents Complete: Personal Information Form
